5
|
Vlachos K, Derval N, Pambrun T, Duchateau J, Martin CA, Bazoukis G, Frontera A, Takigawa M, Nakashima T, Efremidis M, Letsas KP, Bourier F, André C, Krisai P, Ramirez FD, Kamakura T, Takagi T, Nakatani Y, Tixier R, Chauvel R, Welte N, Kitamura T, Cheniti G, Sacher F, Jaïs P, Haïssaguerre M, Hocini M. Ligament of Marshall ablation for persistent atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:782-791. [PMID: 33687764 DOI: 10.1111/pace.14208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 02/09/2021] [Accepted: 02/28/2021] [Indexed: 11/29/2022]
Abstract
Beyond pulmonary vein isolation, the two main additional strategies: Cox-Maze procedure or targeting of electrical signatures (focal bursts, rotational activities, meandering wavelets), remain controversial. High-density mapping of these arrhythmias has demonstrated firstly that a patchy lesion set is highly proarrhythmogenic, favoring macro-re-entry through conduction slowing and providing pivots for localized re-entry. Secondly, discrete anatomical structures such as the Vein or Ligament of Marshall (VOM/LOM) and the coronary sinus (CS) have epicardial muscular bundles that are more frequently involved in re-entry than previously thought. The Marshall Bundle can be ablated at any point along its course from the mid-to-distal coronary sinus to the left atrial appendage. If necessary, the VOM may be directly ablated using ethanol infusion to eliminate PV contributions and produce conduction block across the mistral isthmus. Ethanol ablation of the VOM, supplemented with RF ablation, may be more effective in producing conduction block at the mitral isthmus than repeat RF ablation alone.
Collapse
Affiliation(s)
- Konstantinos Vlachos
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Nicolas Derval
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Thomas Pambrun
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Josselin Duchateau
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Claire A Martin
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France.,Cardiology Department, Royal Papworth Hospital, Cambridge, UK
| | - George Bazoukis
- Arrhythmia Unit, Laboratory of Cardiac Electrophysiology, Second Cardiology Department, Evangelismos General Hospital of Athens, Greece
| | - Antonio Frontera
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Masateru Takigawa
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Takashi Nakashima
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Michael Efremidis
- Arrhythmia Unit, Laboratory of Cardiac Electrophysiology, Second Cardiology Department, Evangelismos General Hospital of Athens, Greece.,Onassis Cardiac Surgery Centre, Athens, Greece
| | - Konstantinos P Letsas
- Arrhythmia Unit, Laboratory of Cardiac Electrophysiology, Second Cardiology Department, Evangelismos General Hospital of Athens, Greece
| | - Felix Bourier
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Clémentine André
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Philipp Krisai
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - F Daniel Ramirez
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Tsukasa Kamakura
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Takamitsu Takagi
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Yosuke Nakatani
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Romain Tixier
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Remi Chauvel
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Nicolas Welte
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Takeshi Kitamura
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Ghassen Cheniti
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Frédéric Sacher
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Pierre Jaïs
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Michel Haïssaguerre
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| | - Mélèze Hocini
- LIRYC, University of Bordeaux, CHU de Bordeaux, Bordeaux France, Service de Rhythmologie, Hôpital Cardiologique du Haut-Lévêque (Centre Hospitalier Universtaire de Bordeaux), Talence, Aquitaine, France
| |
Collapse
|
6
|
Nakashima T, Pambrun T, Vlachos K, Goujeau C, André C, Krisai P, Ramirez FD, Kamakura T, Takagi T, Nakatani Y, Kitamura T, Takigawa M, Roux JR, Cheniti G, Tixier R, Chauvel R, Welte N, Duchateau J, Sacher F, Cochet H, Hocini M, Haïssaguerre M, Jaïs P, Derval N. Impact of Vein of Marshall Ethanol Infusion on Mitral Isthmus Block: Efficacy and Durability. Circ Arrhythm Electrophysiol 2020; 13:e008884. [PMID: 33197321 DOI: 10.1161/circep.120.008884] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Achieving bidirectional mitral isthmus (MI) block using radiofrequency catheter ablation (RFCA) alone is challenging, and MI reconnection is common. Adjunctive vein of Marshall (VOM) ethanol infusion (VOM-Et) can facilitate acute MI block. However, little is known about its long-term success. This study sought to evaluate the impact of adjunctive VOM-Et on MI block achievement and durability compared with RFCA alone. METHODS Patients undergoing the first attempt of posterior MI ablation were grouped according to their MI block index strategy: adjunctive VOM-Et and RFCA alone. Rates of acute MI block and MI reconnection observed during repeat procedures were compared between the 2 groups. RESULTS The VOM-Et group consisted of 152 patients (63.8±9.4 years) undergoing adjunctive VOM-Et for MI block. The RFCA group consisted of 110 patients (60.9±9.2 years) undergoing MI ablation using RFCA alone. Acute MI block was more frequently achieved in the VOM-Et group (98.7% [150/152] versus 63.6% [70/110]; P<0.001) with shorter RFCA duration (5.00 [3.00-7.00] versus 19.0 [13.6-22.0] minutes; P<0.001). Of the 220 patients with MI block achieved during the index procedure, 81 underwent a repeat procedure during follow-up (VOM-Et group: 23.3% [35/150] versus RFCA group: 65.7% [46/70], respectively; P<0.001). A significantly greater number of patients exhibited durable MI block in the VOM-Et group (62.9% [22/35] versus 32.6% [15/46], respectively; P=0.008). CONCLUSIONS Beyond facilitating acute MI block, VOM-Et is associated with greater lesion durability as evidenced by higher rates of MI block during repeat procedures.
Collapse
Affiliation(s)
- Takashi Nakashima
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (T.N., T.P., K.V., C.G., C.A., P.K., F.D.R., T. Kamakura, T.T., Y.N., T. Kitamura, M.T., G.C., R.T., R.C., N.W., J.D., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J., N.D.)
| | - Thomas Pambrun
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (T.N., T.P., K.V., C.G., C.A., P.K., F.D.R., T. Kamakura, T.T., Y.N., T. Kitamura, M.T., G.C., R.T., R.C., N.W., J.D., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J., N.D.)
| | - Konstantinos Vlachos
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (T.N., T.P., K.V., C.G., C.A., P.K., F.D.R., T. Kamakura, T.T., Y.N., T. Kitamura, M.T., G.C., R.T., R.C., N.W., J.D., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J., N.D.)
| | - Cyril Goujeau
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (T.N., T.P., K.V., C.G., C.A., P.K., F.D.R., T. Kamakura, T.T., Y.N., T. Kitamura, M.T., G.C., R.T., R.C., N.W., J.D., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J., N.D.)
| | - Clémentine André
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (T.N., T.P., K.V., C.G., C.A., P.K., F.D.R., T. Kamakura, T.T., Y.N., T. Kitamura, M.T., G.C., R.T., R.C., N.W., J.D., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J., N.D.)
| | - Philipp Krisai
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (T.N., T.P., K.V., C.G., C.A., P.K., F.D.R., T. Kamakura, T.T., Y.N., T. Kitamura, M.T., G.C., R.T., R.C., N.W., J.D., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J., N.D.)
| | - F Daniel Ramirez
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (T.N., T.P., K.V., C.G., C.A., P.K., F.D.R., T. Kamakura, T.T., Y.N., T. Kitamura, M.T., G.C., R.T., R.C., N.W., J.D., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J., N.D.)
| | - Tsukasa Kamakura
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (T.N., T.P., K.V., C.G., C.A., P.K., F.D.R., T. Kamakura, T.T., Y.N., T. Kitamura, M.T., G.C., R.T., R.C., N.W., J.D., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J., N.D.)
| | - Takamitsu Takagi
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (T.N., T.P., K.V., C.G., C.A., P.K., F.D.R., T. Kamakura, T.T., Y.N., T. Kitamura, M.T., G.C., R.T., R.C., N.W., J.D., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J., N.D.)
| | - Yosuke Nakatani
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (T.N., T.P., K.V., C.G., C.A., P.K., F.D.R., T. Kamakura, T.T., Y.N., T. Kitamura, M.T., G.C., R.T., R.C., N.W., J.D., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J., N.D.)
| | - Takeshi Kitamura
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (T.N., T.P., K.V., C.G., C.A., P.K., F.D.R., T. Kamakura, T.T., Y.N., T. Kitamura, M.T., G.C., R.T., R.C., N.W., J.D., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J., N.D.)
| | - Masateru Takigawa
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (T.N., T.P., K.V., C.G., C.A., P.K., F.D.R., T. Kamakura, T.T., Y.N., T. Kitamura, M.T., G.C., R.T., R.C., N.W., J.D., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J., N.D.)
| | | | - Ghassen Cheniti
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (T.N., T.P., K.V., C.G., C.A., P.K., F.D.R., T. Kamakura, T.T., Y.N., T. Kitamura, M.T., G.C., R.T., R.C., N.W., J.D., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J., N.D.)
| | - Romain Tixier
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (T.N., T.P., K.V., C.G., C.A., P.K., F.D.R., T. Kamakura, T.T., Y.N., T. Kitamura, M.T., G.C., R.T., R.C., N.W., J.D., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J., N.D.)
| | - Remi Chauvel
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (T.N., T.P., K.V., C.G., C.A., P.K., F.D.R., T. Kamakura, T.T., Y.N., T. Kitamura, M.T., G.C., R.T., R.C., N.W., J.D., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J., N.D.)
| | - Nicolas Welte
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (T.N., T.P., K.V., C.G., C.A., P.K., F.D.R., T. Kamakura, T.T., Y.N., T. Kitamura, M.T., G.C., R.T., R.C., N.W., J.D., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J., N.D.)
| | - Josselin Duchateau
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (T.N., T.P., K.V., C.G., C.A., P.K., F.D.R., T. Kamakura, T.T., Y.N., T. Kitamura, M.T., G.C., R.T., R.C., N.W., J.D., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J., N.D.)
| | - Frédéric Sacher
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (T.N., T.P., K.V., C.G., C.A., P.K., F.D.R., T. Kamakura, T.T., Y.N., T. Kitamura, M.T., G.C., R.T., R.C., N.W., J.D., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J., N.D.)
| | - Hubert Cochet
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (T.N., T.P., K.V., C.G., C.A., P.K., F.D.R., T. Kamakura, T.T., Y.N., T. Kitamura, M.T., G.C., R.T., R.C., N.W., J.D., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J., N.D.)
| | - Mélèze Hocini
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (T.N., T.P., K.V., C.G., C.A., P.K., F.D.R., T. Kamakura, T.T., Y.N., T. Kitamura, M.T., G.C., R.T., R.C., N.W., J.D., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J., N.D.)
| | - Michel Haïssaguerre
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (T.N., T.P., K.V., C.G., C.A., P.K., F.D.R., T. Kamakura, T.T., Y.N., T. Kitamura, M.T., G.C., R.T., R.C., N.W., J.D., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J., N.D.)
| | - Pierre Jaïs
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (T.N., T.P., K.V., C.G., C.A., P.K., F.D.R., T. Kamakura, T.T., Y.N., T. Kitamura, M.T., G.C., R.T., R.C., N.W., J.D., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J., N.D.)
| | - Nicolas Derval
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, CHU Bordeaux, IHU Lyric, Université de Bordeaux, France (T.N., T.P., K.V., C.G., C.A., P.K., F.D.R., T. Kamakura, T.T., Y.N., T. Kitamura, M.T., G.C., R.T., R.C., N.W., J.D., F.S., H.C., M. Hocini, M. Haïssaguerre, P.J., N.D.)
| |
Collapse
|